Individual
CALLISIA CLARKE
Active
Individual
CALLISIA CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
57012026
OH
208600000X
Surgery Physician
P5611
TX
2086X0206X
Surgical Oncology Physician
Primary
66205
WI
2086X0206X
Surgical Oncology Physician
P5611
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
320489301
—
TX
01
—
8DT082
BCBS
TX
Enumeration date
04/25/2007
Last updated
12/12/2016
Update your record
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